The Deadly Shot
New York Times, Published: November 26, 2005
Millions of people in poor countries get sick and die from a common tool for getting well: the hypodermic syringe. In some countries, most injections are done with needles that are reused without sterilization. Twenty-one million people each year get hepatitis B this way, two million get hepatitis C and 650,000 get infected with H.I.V.
As third-world health problems go, this one seems solvable. Single-use syringes, whose plungers break or are blocked after first use, cost about 6 cents apiece. Countries could simply follow the lead of Botswana and Uganda and ban all other kinds of syringes.
But nothing is ever simple in places where health care is disorganized and threadbare. The biggest problem is that many poor countries are injection-crazy. For every injection given as a vaccination, 20 are given as cures. Many injected medicines are snake oil, and even effective injections are mostly unnecessary, as a pill would work just as well. But patients demand injections because they think the medicine is stronger, and health care workers like to give them because they can charge more.
It is hard for governments to change dearly held beliefs about medicine. Dirty needles kill many years after a shot. In some places, it took a health crisis to bring progress. In Romania, people became aware of the problem of unsafe injection after children in orphanages had been given contaminated blood and vaccinated with dirty needles, resulting in the infamous wave of AIDS infection.
In Burkina Faso, a severe meningitis outbreak helped, paradoxically, by producing an extreme shortage of medicines and syringes. This led the government to reform its medical-supply system. Small pharmacies stocked with essentials including single-shot syringes now exist in health posts throughout the country. From 1995 to 2000, the percentage of injections with reused needles declined in Burkina Faso to 4 percent from 55 percent.
The most direct course is to ban reusable needles. But in countries spending $10 a year per capita on health care, 6 cents a shot is a lot when a traditional syringe can be reused some 200 times.
The Safe Injection Global Network, backed partly by the World Health Organization, is trying to help countries develop educational programs for health care workers and doctors. The Bush administration also works on injection safety as part of its AIDS efforts overseas. But more needs to be done, particularly since such a small amount of money can save so many lives.